patient safety

The term SHO is dead, defunct and in some people’s opinions dangerous. That’s the view of the deanery and the GMC so it’s something that we have been challenged to remove from day to day parlance here at CMFT.

However, much as it is rather tricky to stop people calling the department of emergency medicine…. ‘Casualty’ it’s tricky to stop people using the term SHO. So, in order to make a small step in the right direction you may notice something different when using the VOCERA badges recently introduced at MRI and soon to be used in other areas of the trust.

If, for example, you ask for ‘ED SHO’ the badge will reply ‘Calling ED Core Trainee’. Pretty clever stuff courtesy of infomatics and hopefully a step in the right direction.

Now this is all a bit Star Trek and no doubt you will have had plans

If you want to try out a few easter eggs, try commanding genie with these:
– good bye
– beam me up
– beam me down
– shut up

or if you’re brave command the badge with ‘turn funny genie on’ – remember to turn it off before entering a patient area though

Our Trust’s ‘CMFT International Programme’ was awarded the first prize for ‘Improving Services Through Training and Development’ during the recently concluded Lean Healthcare Academy Conference and Awards 2014. Lean Healthcare Academy Awards are national level awards and our Trust’s entry competed with entries from Health Education North West and South Tees Hospitals NHS Foundation Trust to win the award.

The Trust was represented by Dr Anna Kelsey, Mr Tony Armstrong, Dr Sujesh Bansal and Dr Steve Benington during the award ceremony held in Leeds on 6th February 2014 (photographed). The team thanked Prof. Simon Carley and Mrs Karen Stuart who were not able to attend the evening.

Central Manchester University Hospitals NHS Foundation Trust has introduced an ‘enhanced’ induction for new international doctors and support system (peer buddies and supervisors) to ensure appropriate training and support before international doctors start work in the UK and provide direct patient care. This bespoke online training programme for new international doctors provides information and knowledge on social, ethical, legal, professional and patient safety aspects of patient care and UK clinical practice. This programme was introduced in August 2012 and in the last 18 months, 42 international doctors have completed the programme with an increasing number registering and completing the online induction. 95% of doctors have found the training useful in enhancing the patient care they provide.

CMFT International Programme has been shared with national bodies like GMC, AoMRC, REACHE and Royal Colleges; and have been appreciated by them. Many national organisations are keen to provide our ‘enhanced’ induction programme to their sponsored new international doctors.

If you need any further information about CMFT International Programme, please contact Postgraduate department at 01612766647 or Dr Sujesh Bansal ([email protected]), Trust International Tutor.

Not a lot of people know this, but 75% of the self proclaimed SimWars champions of the world are here at CMFT.

WARNING – slight conflict of interest coming up.

What is SimWars?

SimWars was invented in the US as the antidote to ‘touchy-feely’ feedback in resuscitation education. The basic premise is that teams of clinicians are tasked to perform a live simulated resuscitation in front of an audience. Each team is scored against clinical care, team working, leadership and overall performance.

This is resuscitation with competition. It’s performed live, in front of an audience of peers and in some cases with the world watching. Unsurprisingly it originated in America and you can hear a little bit more about it in the video below.

You may well ask! This is not just about education, it’s not just about entertainment, it’s a combination or ‘Medutainment’ if you like inventing words. SimWars is about making learning fun and challenging. Sure, it’s not going to replace formal educational events, but every so often teams might just want to let their hair down and engage in a bit of friendly competition.

The teams performed live in front of an audience of 600 people at the Sydney Conference Centre, with the whole event being screened live to thousands around the world. This was a little stressful to be honest, but despite this the team used the power of the internet and #FOAMed to resuscitate and save the patient who had suffered a snake bite to a part of the anatomy that we cannot mention here………(remember that this was Australia).

The team in action at SMACC 2013The patient’s wife chose to bring the snake to the resuscitation area – we do not recommend this….!

Clearly we were delighted to win the audience vote and just like the England cricket team of late we came away with the spoils of victory.

So would SimWars work in England and at CMFT?

Well, it’s been tried in London with great success for Emergency Medicine trainees there, so yes, but I also wonder if this is something that we could do here at CMFT? Would there be interest from departments across the trust in putting forward a team for a hospital wide SimWars at some point in 2014? We have the kit, we have a team of trainers and we have some fantastic resuscitationists so the elements are here, but only if there is enthusiasm for standing up in front of colleagues and showing us what you’re made of. We have a simulator up and running in the ED and there are many others around the trust, at undergraduate level all our 5th year students will be receiving simulation training this year so I’m confident that there should be some willing teams out there…., but are there?

It would certainly spice up a grand round or local educator conference….., so I’m really interested to hear what you think.

And what about a return?

Well, it’s next year to be honest. The team is returning to the Gold Coast of Australia in March 2014 at SMACC Gold to defend the title and we are expecting a tough time as the Australians aim to take the trophy back. This year we hear of teams from the USA, Ireland and Europe so the competition will be of an even higher standard than in 2013. We look to the England cricket team can set the standard by retaining the Ashes this winter, but even if they don’t we aim to do England proud down under.

I’ve recently been forced to consider the longevity of the SHO grade. This is not an idle pursuit but a requirement as over the last few years there have been a number of patient safety reports highlighting the difficulties in the use of the term SHO, or ‘senior house officer’. The title has not existed as a training grade for many years (2005?? if I remember rightly), but the term remains in common parlance.

Is this a problem?

Well, if usage is anything to go by, then to some it isn’t. It appears to be widely used by a variety of different staff perhaps having become one of those terms that is difficult to define, but seemingly everyone knows what it means….

Or do they?

We have pretty much disbanded the term house-officer in favour of foundation doctor (although some die-hards do remain), but SHO seems more sticky. It is an all encompassing term that links years 1-3 core/specialist training posts. FY2 docs, clinical fellows, trust fellows and a bunch of other trainees into one amorphous mass which belies the variability in experience and skill within. There is clearly a significant difference in experience (and ability) between an FY2 and an ST3 so it is disingenuous and potentially dangerous to consider them to be all the same….., a nurse (for example) requesting an ‘SHO’ to see a patient may get a doctor with wildly different levels of experience and that can’t be good. So why does the term continue? I think it is a mixture of convenience and history. SHO rolls off the tongue in a way that ‘core trainee, year 1, Acute Common Care Stem (Emergency Medicine)’ does not. It just does. and there is little we can do about this, but that does not mean that it is unimportant. The question has been raised as a patient safety concern by the deanery and by national bodies for good reason, so we must do what we can to change the current custom and practice. Here at CMFT we are going to try the following.

Stop the issue of ID cards with ‘SHO’ on them.

Stop doctors from trying to choose their own titles for ID cards.

Don’t advertise any job as an SHO post.

Change rotas to reflect true grade and not ‘HO’ or ‘SHO’

Use alternative grading systems. For example In the ED and medicine we use different coloured lanyards to designate roles and responsibilities (so the whole team can see who is operating at whichever level in the clinical setting).

Will this work? We hope so as we’d like to think that the term ‘SHO’ is dead….., my concern is that it might only be resting unless we take steps to make sure that he not just (as Monty Python might say) pining for the Fjords……

Like this:

I’ve seen an interesting document today from the Royal College of Physicians about what we can and perhaps cannot expect of the medical registrar when on call in acute hospitals. The main document can be found here….

Firstly, I love the concept of ‘physicianly’ specialities, it’s clearly an underused word and I think we should hear it more.

Secondly, there is some important information here about what we can expect middle grade physicians to be able to do in terms of practical skills. This perhaps reflects a changing training program and a greater oversight of assessment of competence to increase patient safety which is no bad thing.

Here at CMFT we have a number of strategies to ensure that doctors are fit for their role including the use of simulators for procedures such as chest drains. In addition there is excellent support from the critical care and anesthetic teams for some of the procedures on the list such as central venous catheterisation.